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Clinical Science
Association of diabetes with age-related macular degeneration in the EUREYE study
  1. F Topouzis1,
  2. E Anastasopoulos1,
  3. C Augood2,
  4. G C Bentham3,
  5. U Chakravarthy4,
  6. P T V M de Jong5,
  7. M Rahu6,
  8. J Seland7,
  9. G Soubrane8,
  10. L Tomazzoli9,
  11. J R Vingerling5,
  12. J Vioque10,
  13. I S Young11,
  14. A E Fletcher2
  1. 1
    Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
  2. 2
    Department of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
  3. 3
    Centre for Environmental Risk, University of East Anglia, Norwich, UK
  4. 4
    Department of Ophthalmogy, Queen’s University of Belfast, Belfast, UK
  5. 5
    The Netherlands Ophthalmic Research Institute, KNAW, and Department of Ophthalmology, Academic Medical Centre, Amsterdam, The Netherlands
  6. 6
    Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
  7. 7
    Øyeavdelingen, Haukeland Sykehus University of Bergen, Bergen, Norway
  8. 8
    Clinique Ophthalmologique, Universitaire De Creteil, Paris, France
  9. 9
    Clinica Oculistica, Università degli Studi di Verona, Verona, Italy
  10. 10
    Departamento Salud Publica Universidad Miguel Hernández, Alicante, and CIBERESP, Ciber de Epidemiología y Salud Pública, Alicante, Spain
  11. 11
    Centre for Clinical and Population Sciences, Queen’s University of Belfast, Belfast, UK
  1. Correspondence to Dr F Topouzis, Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, S Kiriakidi 1 54636, Thessaloniki, Greece; ftopouzis{at}


Objective: To examine the association between self-reported diabetes history and early or late age-related macular degeneration (AMD) in the European population.

Methods: Participants aged 65 years and over in the cross-sectional population-based EUREYE study underwent an eye examination including digital retinal photography. The images were graded at a single centre. A structured questionnaire was administered by trained field workers for putative risk factors for AMD including history of diabetes mellitus. Logistic regression models were used to examine the association between diabetes and stages of AMD, taking account of potential demographic, behavioural, dietary and medical (history of cardiovascular disease) confounders.

Main outcome measures: Photographic images were graded according to the modified International Classification System for AMD and stratified into five exclusive stages from no signs of AMD (AMD stage 0), early AMD (Stages 1–3) and late AMD (Stage 4). Late AMD was subdivided in neovascular AMD (NV-AMD) or geographic atrophy (GA).

Results: Data on diabetes history and potential confounders were available in 2117 control subjects without AMD, 2182 with early AMD, 49 with GA and 101 with NV-AMD. Of all participants, 13.1% reported a history of diabetes. After adjusting for potential confounders, subjects with neovascular AMD compared with controls had increased odds for diabetes (odds ratio 1.81; 95% confidence interval, 1.10 to 2.98, p = 0.02). Subjects with AMD grades 1 to 3 or GA had no increased odds for diabetes compared with those without AMD.

Conclusions: In the EUREYE study, after multiple adjustments, positive association of diabetes mellitus with neovascular AMD was found. The hypothesis that diabetes is associated with neovascular AMD but not with geographic atrophy may suggest a different pathogenesis of the two advanced forms of the disease and needs to be further evaluated.

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  • Funding European Commission Vth Framework, Brussels, Belgium (contract no QLK6-CT-1999-02094). Additional funding for cameras was provided by the Macular Disease Society, Andover, UK. MR was financed by the Ministry of Education and Science, Tallinn, Estonia (target funding no 01921112s02). Additional funding in Alicante was received from the Spanish Ministry of Health (Grants: FIS 01/1692E; CIBERESP). European Eye investigator meetings were supported by travel grants from Novartis, Basel, Switzerland, and Pfizer, New York.

  • Competing interests None.

  • Ethics approval Ethics approval was obtained at each centre from the relevant ethics committee.

  • Patient consent Obtained.

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